Superbug Summer Books:
THE POWER OF HABIT
This happens practically daily. The pattern distresses me; I spend a fair amount of effort trying to dislodge it; I fail.
So you can imagine how I latched onto Charles Duhigg’s book “The Power of Habit: Why We Do What We Do In Life and Business” (Random House). Duhigg is a Times investigative reporter, and his book is a reporter’s book: absorbing, wide-ranging, thorough, deeply sourced, and intelligently analytical about the patterns that people — and organizations and societies — pursue without conscious intent. It is very good, and lots of people think so: The book was published in March and as of this weekend has been on the New York Times’ hardcover nonfiction best sellers list for 19 weeks.
“The Power of Habit” helped me understand my own behavior loops — but I thought it had a lot to say, as well, about unproductive habits in medicine and agriculture. For the fourth installment of Superbug Summer Books, I talked to Duhigg by phone and edited and condensed our chat.
Maryn McKenna: I feel as though everyone struggles with their habits and wants to change them, which must make this book universally appealing. Did you come to the topic for personal reasons?
MM: You talk in the Prologue about being assigned to Iraq, and meeting an Army major who had changed the habit of public gathering for an entire small town called Kufa – thus defusing anti-American demonstrations – and how this made you realize that habits could be learned and changed.
CD: This is a guy who by his own estimation was not set up to be successful in life. He talked about how a whole bunch of his friends had become either meth addicts or meth dealers, and that he was clearly on that path, and that he had never been successful until he joined the military. He said that the entire reason why he was successful — and he was really accomplished — was all because the military had taught him how to establish habits. I thought that was really interesting. I came back to the States — this was back in 2003-2004 — and I started looking into this because I thought maybe I could use some of the science to guide my own life.
MM: Once you started to dig into this, did you feel like you’d been handed some sort of golden key?
CD: It was kind of a slow process, because there is so much research on this that it was hard to aggregate. There would be one study that looked at travel habits when people go on vacation, and another study about how people quit smoking. I couldn’t find anything that said, “Here’s the magic key that will help you unlock all of your own habits!” That was part of why I decided to write the book: I felt it would be an opportunity to put all these disparate studies into one framework that would hopefully be helpful to people.
MM: I was struck by how many of the social patterns I examine as a journalist could be construed as habits, and started to wonder whether viewing them that way could supply a lever to change them. For instance: antibiotic misuse. Specifically, how difficult it is to get patients to not expect an antibiotic prescription at the end of a doctor’s office visit, whether or not the prescription is warranted. It’s the ending we have trained them to expect.
CD: It’s interesting that you pose it that way, because you’re describing the three parts of the habit loop: the cue, the routine and the reward. We know from experiments and studies that by far the most important is the reward. Everything is driven by it. I’ve had the exact same experience. You go into the doctor’s office and you want something that you think is going to improve the odds of healing. And oftentimes they don’t have anything to give you but antibiotics. The physician has to be able to give the patient something in its place, something that is more satisfying than saying, “Just wait and it will get better,” and I’m not sure that there is anything else to give.
MM: So, habit expert, what could change this pattern?
CD: I’m not certain that this is a habit for the patient, because habits are repeated activities that are performed sort of semi-consciously, and people go to the doctor so infrequently that I’m not sure this applies to them. But it certainly does apply to the doctor, because the doctor is seeing patients constantly, and gets into a routinized pattern about how to deal with a particular complaint. And what’s really interesting, is that, for the doctor, there is clearly a reward in writing the scrip: The patient stops complaining, is happy, and goes home.
So if we’re going to change doctors’ habits, we have to provide them with some similar type of reward for a new routine. We need to somehow reward them not-giving the scrip. Maybe it’s a payment bonus structure that’s tied to how many antibiotics scrips they are giving out, or not. Or maybe it’s mentors inside the practice saying, “I really appreciate that your patients were pushing for antibiotics and that you weren’t writing prescriptions willy-nilly, and I want to acknowledge it and reward you for it.”
Positive reinforcement creates habits much, much faster. You’re much better off creating positive rewards, complimenting people for acting correctly, rather than punishing them when they act incorrectly.
MM: I want to see if we can apply the habit-loop analysis to one of my other big topics, which is agricultural use of antibiotics as opposed to human-medicine use. Agriculture clings to this, but there is a lot of citizen and now legal pressure for the industry to change. Is it possible to alter behavioral loops by outside pressure? Or does change happen only, you know, when the lightbulb really wants to change? (Sorry.)
CD: There are a lot of examples where pressure from the outside has been effective. Though I would say they’re not mutually exclusive, the outside pressure and the desire to change; in fact they probably have to become synonymous. One of the best examples of this is the campaign against Nike and Reebok regarding overseas labor conditions. Initially you saw a huge pushback. Activists attacked these companies, saying, “You’re using children to make your shoes,” and the companies reacted very negatively, saying, “We don’t have any other choice, we have to do it this way — and by the way it’s not as bad as you say it is.” And then they realized that they were simply accepting the conventional wisdom, that it was cheaper to work overseas, and they began reevaluating. There were leaders who said, “Look, there are two rewards here. One reward is that we can reform our manufacturing without taking any economic hits. The other reward is that we can become an industry leader on more humane manufacturing systems.” And today actually Nike is seen as an industry leader on social responsibility, and they get a lot of social reward for that, and can take a moral high ground.
So when we have seen external pressure create social change around industrial habits, what has often occurred is that in addition to the negative reinforcement of people attacking them, there’s also been positive reinforcement of people saying, “Nike used to be a bad company, now it’s the best when it comes to social responsibility.”
MM: If that’s the case, then how do outside activists know where to apply pressure? You talk in the book about achieving small wins, and also about identifying the “keystone habit” – the thing that, once it is changed, makes other changes fall into place.
CD: The way you identify keystone habits is that you look for things that have emotional resonance. When I talk to companies about how they changed, what people often say is, “The way I discovered the keystone habit is, I tried to figure out what kind of change scared me the most. Not ‘worried me the most,’ not ‘concerned that the numbers weren’t going to line up’; scared me the most.” That’s how you know.
This is part of an intermittent series I’m running this summer about books I like and think you should take a look at. Some of the books are directly related to this blog’s core topics; others I just think are cool. You can find my picks at #SBSBooks on Twitter.
Superbug Summer Books: THE POWER OF HABIT | Wired Science | Wired.com